Pain Medication

Pain medications can be divided into several different groups. These groups range from herbal and over-the-counter (OTC) pain medications, which are available without a healthcare provider's prescription, up to highly controlled opioid medications. All pain medications should be taken exactly as recommended by the manufacturer or prescribed by a healthcare provider, as all these medications have the potential for side effects or adverse reactions. It is important when prescribing these medications that healthcare providers ascertain all medicines the patient is taking, including other over-the-counter medications and herbal supplements, to avoid possible drug interactions.

A systematic review of 10 randomized controlled trials of patients with low back pain has found that herbal preparations of devil's claw (Harpagophytum procumbens), white willow bark (Salix alba), and cayenne plasters (Capsicum frutescens) may be as effective as pain medication for short-term pain control. However, the medical community still holds major concern around herbal remedies, as the manufacturing process of these substances is not regulated and there seems to be a lack of consistency of the preparations. A second concern is the potential for drug interactions with traditional medicine, which has yet to be fully determined.

OTC pain medications are typically found in three basic groups: topical preparations, nonsteroidal anti-inflammatory drugs (NSAIDS), and acetaminophen. Topical corticosteroids are mainly used for local inflammation in the skin, such as acute flairs of eczema, and are rarely used for control of pain other than superficial pain. Capsaicin, a substance found naturally in chili peppers, is used in some topical analgesic creams. It is best used with superficial pain, as it can change pain signals at the level of the skin without blocking other sensations. Acetaminophen (called “paracetamol” outside North America and goes by the brand name Tylenol) was first used in medicine in 1894 but did not become popular as a pain medication until the late 1940s. Acetaminophen is available in multiple dosages and preparations, such as tablets and elixirs, so as to be tailored to the individual by weight and age. Users of acetaminophen should follow the directions exactly as they are stated because of the risk of liver damage and potential for liver failure. Acetaminophen is three times as likely to cause liver failure as all other drugs combined. It is the most common cause of acute liver failure in the United States. Most often, liver failure is associated with overdosing, but even at recommended doses, if it is taken with alcohol, it can cause irreversible liver failure.

NSAIDS include medications such ibuprofen (Advil and Motrin), naproxen sodium (Aleve), and ketoprofen (Orudis KT). Many of these medications are also available in a stronger prescription-strength dosage too. These medications tend to reduce inflammation, and the pain associated with inflammation, by preventing the body from manufacturing prostaglandins. Prostaglandins are substances that act as mediators of pain and inflammation. However, these same prostaglandins also protect the lining of the stomach. Use of NSAIDS should be monitored closely for stomach upset and gastrointestinal bleeding, the risk of which goes up with long-term use of these medications. The risk of liver failure is much less with NSAIDS than with acetaminophen. Aspirin is classified as an NSAID but is unique in some of its properties. In addition to reducing pain and inflammation, it acts as a blood thinner and can help prevent blood clots. Aspirin, too, has some risk with use, and it should not be taken by children under 16 who have chicken pox or flu symptoms due to the risk of Reye's syndrome, characterized by acute encephalopathy and liver failure.

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